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The Journal of Headache and Pain

Study: Moderate Aerobic Exercise for Migraine

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There are a whole host of lifestyle and exercise recommendations for fighting migraine. A fascinating study published this month in The Journal of Headache and Pain looked at how much solid evidence there is for various types of “therapeutic exercise”, and included studies of everything from high-intensity interval training to relaxation techniques.

swimming - excellent aerobic exercise!

Each type of exercise was given a grade from B to D. What will especially catch your eye are the specifics about aerobic exercise, so let’s take a closer look.

As I studied, I was surprised to discover that I was a little weak on the actual definition of “aerobic”. Citing The American College of Sports Medicine (ACSM), this article from the National Library of Medicine defines “aerobic exercise as any activity that uses large muscle groups, can be maintained continuously and is rhythmic in nature”. “Aerobic” refers to the use of oxygen, so think of anything that requires extra oxygen. But that’s not necessarily sprinting – it could be much less intensive, such as walking.

Other examples would include jogging, swimming, and stair climbing.

As you can tell, there is actually a wide range of aerobic activity. So what has the best evidence as a migraine-fighter? Several studies recommended aerobic exercise in general, and some specifically “moderate-intensity continuous aerobic exercise”. Low intensity did not seem to do as well as moderate intensity, but it still earned a “C” score on the evidence scale.

So basically, any aerobic exercise is a step in the right direction, with moderate-intensity having the most studied benefits. Moderate aerobics three times a week is the specific recommendation.

The benefits found in the studies included:

  • Decreased pain frequency
  • Decreased pain intensity
  • Decreased pain duration
  • Decreased disability
  • Increased quality of life

That may seem vague, but remember that these were studies specifically designed to measure improvement, so this is more than just “I seem to feel a little better”. This is a significant improvement.

For those with migraine, it seems to be wise to start slowly and gradually increase the intensity of your exercise, being sure to stay hydrated. The Cleveland Clinic has a great article introducing aerobic exercise here.

Also, the American College of Sports Medicine has a chart explaining “intensity” more specifically. Don’t get nervous – if you can add any kind of movement to your life, it should help your quality of life. These exercises don’t need to be intense – but you will need to push yourself a little. Here’s the chart: Tips for Monitoring Aerobic Exercise Intensity.

Is Cluster Headache a type of Migraine?

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In its clinical description, there’s no doubt that the symptoms of cluster headache are quite different from migraine. There has been some confusion in the past (such as the unfortunate term “cluster migraine“), but we’ve talked more than once about the differences.

Cluster and Migraine debate

For a quick primer, check out this migraine-cluster headache infographic. For more detailed similarities and differences, go to Cluster or Migraine: What’s the Difference?

All that being said, “migraine” is not one thing either. There are many different types of migraine with different symptoms, and in some cases with different treatments. Since we’re still learning about what causes the migraine chain reaction, and what really causes cluster headache, the question arises – is there actually a similar cause? Is this one disease that manifests itself in different ways? If so, although treatment options are quite different now, might there be some future treatments that address both?

The debate was opened up again late last year in The Journal of Headache and Pain, in a review with the appropriate title, “Debate: Are cluster headache and migraine distinct headache disorders?“

The article discusses some of the challenges when it comes to making a hard-and-fast decision. There are certainly a lot of similarities, but also a lot of differences. There is no symptom that only appears in migraine and cluster and nothing else (it would be easier if you knew that, as soon as your nose turns purple, it’s either cluster or migraine). Should we look more at treatments – diagnosing based on which treatments work? This is fraught with complications as well.

The authors give us a helpful summary, so here’s a summary of the summary. Yes, cluster and migraine share not only some symptoms during the attack, but also symptoms in-between attacks (such as visual hypersensitivity – being sensitive to bright light between attacks, for example). There are also genetic similarities, similarities in demographics (what “kinds” of people get migraine or cluster), and similarities in certain triggers (they’re basically talking about triggers in a lab – give Joe this drug, it will trigger a cluster attack. Give JoAnn the same drug, it will also trigger an attack).

But these are overlapping similarities. There are some genetic features the same, and some different. There are some symptoms the same, and some different. Cluster is also triggered “more quickly” – telling us that perhaps the “chain reaction” that leads to the symptoms is different for each.

So basically, we need to know more about each. For the time being, we still look at what has “worked best”, we still recognize that everyone is an individual and so needs individual treatment. But we do encourage further discussion and research, because the more we understand, the better treatments can become.

If you’d like to get deeper into the topic, check out this actual video debate between Dr. Anja S. Petersen and Dr. Kuan-Po Peng. They talk not only about the scientific evidence, but also the practical implications of a more or less marked divide between the two.

Smells and Migraine: Getting Worse?

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Sensitivity to odours is osmophobia. Yes, this can refer to a fear of smells, but the hypersensitivity to smells related to migraine applies as well.

migraine stinks
I was going to include a picture of perfumes here, but just the picture made me feel like I was getting a headache. Try it for yourself! If you dare…

A study published in the Journal of Headache and Pain last month provides some interesting insights into common sensitivities and also a possible progression of the symptom.

The researchers, in this case, recognized that many “migraine symptoms” are not only present during an attack, but also before, after, or between attacks – or all the time. This is important to understand for people who still think that migraine only affects you when you have a “migraine headache”.

The biggest offenders probably won’t surprise you. The easy winner was “sweet perfumes”. But next to that, the odours of various foods, cigarette smoke, and exhaust fumes were common offenders. All of these sometimes covered all categories above in the sense of when they were a problem, some being bothersome all the time, and all for some people were considered triggers.

Also not surprising was that if a smell bothered you before an attack, it was likely to bother you during an attack. If it bothered you during an attack, chances were better that it would bother you all the time.

Perhaps most interesting in this study were the age differences. Patients who tended to be sensitive to certain smells between attacks tended to be about 10 years older, and/or they had had migraine for 8 years longer. This may indicate that migraine sensitivity does progress. Would the osmophobia be less if migraine had been treated properly in the early years? This study didn’t address the question, but it seems possible.

Some good news is that people with a high sensitivity to odours did not necessarily seem to be more disabled in general. In other words, although obviously this is a part of the migraine disability, it doesn’t seem like it is necessarily a sign that your migraine is getting more severe. A possible exception were those who became especially sensitive just before a migraine attack.

It may also be encouraging to know that the researchers found that patients were not nearly as likely to have an attack triggered by a certain odour as was believed from an earlier study. It could be that certain smells become more intense and annoying at certain times, such as right before an attack. But that does not necessarily mean that the perfume or whatever is actually triggering an attack.

For more on the study, check out Interictal osmophobia is associated with longer migraine disease duration.

Massive Study on Headache Statistics

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Just how common are headache disorders? This is an extremely difficult question, in spite of the statistics that are thrown around as if they’re certain.

A new study out of Norway, published in The Journal of Headache and Pain, is giving us a new way to look at headaches and migraine from a global perspective.

Researchers took 357 publications, not just adding up the numbers, but looking carefully at how the study was done, to come up with some new estimates for 1961-2020.

Age & Gender

Here is just a sample of the findings of the study. First, 52% of the global population has suffered from a headache disorder of some kind this past year. Here’s what that looks like:

Global headache statistics
Global Headache Statistics

What I call “chronic headache” here is defined as a headache more than 15 days a month (H15+ in the study).

In agreement with many other studies, headaches are more common in women than in men. The difference is significant, if not huge, until you get to migraine. In migraine, about twice as many women had migraine than men (which means of course that we should ignore men’s migraine). Another interesting migraine fact was that, unlike many other headache disorders, it does tend to be lower if you’re under the age of 10 or over 65.

Geography

The study also looked at geographical location. A possible limitation of the study was that most of the research has been done in wealthier countries. However, from what this study could tell, Southeast Asia, East Asia and Oceania was the best place to be, with lowest headache prevalence.

Headache is generally more common in the North Africa/Middle East region. Migraine, however, was most common in South Asia, as was chronic headache. Tension-type headache peaked in high income countries.

Headache today?

Do you have a headache today? On any given day, about 15.8% of the world population have a headache of some kind. Almost half of these – 7%, are migraine.

Progress through the years?

There hasn’t been a huge change overall in the prevalence of headache over the past few decades, which is not particularly encouraging. But there’s worse news. Migraine actually seems to be increasing.

Why would that be? Is it just that we are more aware of migraine, and so are diagnosing it more often? Or are there environmental factors (technology, pollution, change of diet, et cetera) that are making a difference?

The researchers did discuss this question, extensively. As with all of these statistics, in spite of careful research, it is very difficult to say with certainty exactly what the numbers are. But thanks to a lot of hard work, we do have some clues to help us more forward, and keep fighting back against headache. We still have a long way to go.

For more, you can read the abstract and the complete study here: The global prevalence of headache: an update, with analysis of the influences of methodological factors on prevalence estimates

A quicker summary can be found in ScienceDaily: Global estimates of headaches suggest disorder impacts over 50 percent of the population

Sensory Seeking vs. Sensory Avoiding in Adolescents with Migraine

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Don’t be scared away by the headline. This is a somewhat expected, and yet rather interesting to think about, study of adolescents with migraine.

Behaviour is sometimes divided into the categories of “sensory seeking” and “sensory avoiding”. Yes, you probably already have a general idea what we’re talking about, but stay with me.

Bed bouncing. With lots of lights.
Overstimulated? (photo credit: Adnan Islam)

A “sensory seeking” individual seems to want or need more sensory input. A “sensory avoiding” individual may want to avoid more sensory input. We’re talking about colours, smells, noise, and so on. And these behaviours can sometimes be seen in the same person.

So if you were to guess, which category would a migraineur tend to fall into? Well, sensory avoiding, of course. Because migraine patients tend to be more sensitive, even when they’re not in the middle of a migraine attack.

This tends to be the case with adolescents as well, as a recent study confirms. This was not universally the case – but again, chances are the person with migraine is more likely to be a sensory avoider.

And this pattern connects with other issues, such as feelings of helplessness, “rumination” (a focus on your symptoms, causes, and consequences), and more pain. And this could lead to worse disability over time (for more on this, see Pain Catastrophizing and Your Headache).

This web of cause and effect is tricky. The answer is not that we need to turn an “avoider” into a “seeker”. However, it is helpful to recognize the difference. Essentially, to realize that not everyone is like you!

For example, let’s imagine a seeker and an avoider both live in the same house. One likes to do their homework with music playing, one does not. Guess what? It may be more than just simple preference. The music may really help the one person, it may really hinder the other.

How about incense in the house? Same thing. Two children – one likes to play rougher than the other. A “seeker” may stand really close to you when they talk – an “avoider” may back away. A seeker loves loud, sudden noises – an avoider just really does NOT.

Being aware of some of these differences does two things:

  1. It teaches us how to care about others – we really do wonder why everyone isn’t like us. It’s just human nature. Remember, that person may not just be “overly sensitive” or “unreasonable” or “just being difficult”. They may actually be quite different from you.
  2. It may be a warning sign of worsening migraine disability – if you’re seeing avoidance, it’s another reminder that this person needs to be diligent about finding good migraine treatment before things get worse.

For more on this topic, check out:

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The articles on Headache and Migraine News are © 2004-2024 J. Cottrill.
Every effort is made to ensure the accuracy of each article, and to point you to further sources of information. However, this site is for informational purposes only and should never replace a visit to your doctor.